Soapbox

September 8, 2013 11:30 pm

Doctors need lessons in management

By Peter Pramstaller

Physicians need the kind of business skills that MBA students learn

Doctors are struggling. A study* on burnout in the workplace, published last October, showed that nearly one in two physicians feels emotional exhaustion or regret about their choice of career. Doctors see themselves as victims in a workplace that has been taken over by administrators and bureaucrats; consultants bringing in the latest efficiency tools; forms and paperwork that have replaced time with patients; and a demand that they place economics above patient care.

Over the past few decades medicine has rapidly turned from a craft into a business. But doctors are not trained to run businesses – they are trained to heal patients. This disconnect means that doctors have been pushed aside in their own industry. To regain control over their professional lives – and over the future of their profession – they need business training. But as yet no one has figured out how best to provide such training.

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Throughout history, until this generation, doctors have been lone healers, answering to no one except their patients. Doctors merely needed to be concerned with the medicine; everything else would take care of itself. Medical education has reflected this – across the world, the medical school curriculum is focused exclusively on diagnosis and treatment. Doctors learn how to heal, but not how to practise. The nuts and bolts of working as a doctor – dealing with staff, setting up an office, managing a budget with ever-increasing demands, the commercial realities of the real world – are not just ignored but deliberately removed from a doctor’s training, seen as tarnishing the purity of patient care.

In a perfect world, this is not a bad thing. We want doctors to be focused on patient care above all else. We do not want them making medical decisions based on cost. But the institutions where doctors are practising are forced to think about profit even when the doctors themselves do not. Too often, outsiders are brought in to increase productivity, putting demands on doctors that take away their freedom and autonomy, turn medicine into an assembly line, and, in the end, can hurt the patients they are trying to help. Efficiency is prized above all else – but the single-minded focus on efficiency ignores the reality that medicine is practised by human beings, and frustrated, disempowered doctors are not the people we should want taking care of the sick.

Doctors need to be given the tools to regain control. They need training to learn how to work together, to lead and to spend their time in effective ways. They need to be managers and supervisors as well as diagnosticians. In other words, they need the kinds of skills that business students learn. Some business schools do offer joint MD/MBA programmes, but these can serve only a small, elite audience at best – and to some extent an audience that ends up in consulting and business roles rather than back in practice.

What is needed is business education that touches doctors at all levels and is fully integrated into the profession. In the 21st century every doctor needs this kind of training; whether as part of residency training or as a short, easy set of tools that can be taught without the need for a full MBA programme (and the time and expense that would entail).

Such training needs to be built directly into the education system. And, on a more widespread level, thinking needs to change, otherwise business training for doctors will never find itself at the top of any doctor’s agenda.

I firmly believe that to ensure a satisfying and productive future for doctors worldwide, we need to spread useful leadership lessons to the entire profession. One doctor, with the right mindset, can rescue himself. A handful of doctors can rescue a hospital. Eventually, my hope is that many doctors can rescue the whole system, and, with the right business tools, continue to flourish and truly be the ones to lead medicine forward. We owe it to our patients and to ourselves.

*Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Shanafelt TD et al. Arch Intern Med. 2012;172:1377-85.

The author is a neurologist at the Central Hospital of Bolzano (Italy) and scientific director of the Center for Biomedicine at the European Academy of Bolzano.

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